Healthcare Provider Details

I. General information

NPI: 1457776056
Provider Name (Legal Business Name): NWAMMIRI OKORAFOR B. PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 OAKWOOD BLVD
MELVINDALE MI
48122-1150
US

IV. Provider business mailing address

3600 OAKWOOD BLVD
MELVINDALE MI
48122-1150
US

V. Phone/Fax

Practice location:
  • Phone: 313-382-3996
  • Fax: 313-382-3989
Mailing address:
  • Phone: 313-382-3996
  • Fax: 313-382-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302037956
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: